I am Campaigns and Networking Coordinator at Baby Milk Action, which monitors the baby food industry. Our aim is to protect breastfeeding and babies fed on formula from practices that put profits before health. This is a daily look behind the scenes of the work of Baby Milk Action, including the boycott of Nestlé (the worst of the baby food companies), which we promote in the UK. See the Baby Milk Action website if you are unfamiliar with our work.

It really demonstrates how important and necessary it is to keep up pressure on this most unethical of companies through the boycott and by working for legislation.

Nestle falsely claims the formula fliers found by The Guardian in Bangladesh are permitted by the World Health Assembly marketing requirements. Nestlé states: "This is the action of a company committed to improving the health and nutrition of mothers and infants, rather than one trying to exploit grey areas of the code."

It is perhaps easier to make an untrue assertion than it is to explain the truth of the situation. I hope you will have patience to see what the marketing requirements actually say to understand how and why Nestlé is flouting the provisions.

Here is how Nestle attempts to justify the promotional fliers for its Lactogen infant formula which were found by The Guardian in hospitals in Bangladesh:

---Save the Children alleges that Nestlé gives health professionals pictures of Lactogen to pass on to mothers in order to get around the code's prohibition of direct contacts between mothers and companies. The article describes these leaflets as "to all intents and purposes flyers for the product concerned". But giving information to health workers is permitted by the code.Had the article illustrated a copy of one of our so-called flyers, readers may have been more sceptical of the assertion of exploitation.

Nestlé sells three types of Lactogen in Bangladesh. The products have different formulations and feeding frequency. Should an infant consume the wrong product, this would have an adverse effect on the child's health. The leaflets are essentially a safety measure to ensure that the right product is bought for a child of the corresponding age and that the mother understands how frequently she should feed the child.---

Nestle states that giving information ot health workers is permitted by the code. This is what it says in Article 7.2 of the Code.

---7.2 Information provided by manufacturers and distributors to health professionals regarding products within the scope of this Code should be restricted to scientific and factual matters, and such information should not imply or create a belief that bottle feeding is equivalent or superior to breastfeeding.---

So far, so good. Nestlé can provide scientific and factual information to health workers. But Nestlé goes on to admit the fliers are for handing on to mothers so the correct product is bought. Nestlé's Robin Tickle was quoted in the original Guardian article stating: "Individual sheets of these are then indeed handed over to mothers, but only after the infant formula has been prescribed by a doctor."

The Code is very clear. Yes, companies may give scientific and factual information to health workers. But the health care system may not be used to promote breastmilk substitutes to parents. Nor may information on infant feeding refer to brand names.

---6.2 No facility of a health care system should be used for the purpose of promoting infant formula or other products within the scope of this Code. This Code does not, however, preclude the dissemination of information to health professionals as provided in Article 7.2.---

So, yes, the information can be given to health workers, but explicitely not for handing on to mothers.

---6.3 Facilities of health care systems should not be used for the display of products within the scope of this Code, for placards or posters concerning such products, or for the distribution of material provided by a manufacturer or distributor other than that specified in Article 4.---

Nestlé has admitted its fliers are for mothers. A clear breach of both these articles.

But what of Article 4? That concerns educational materials prepared with the written permission of the appropriate government authority or within its guidelines. But even if we view Nestlé's product fliers as education material Article 4 is abundantly clear:

---...Such equipment or materials may bear the donating companys name or logo, but should not refer to a proprietary product that is within the scope of this Code, and should be distributed only through the health care system.---

In other words, fliers handing on for mothers cannot have information about Lactogen infant formula. This is a clear breach however you look at it.

Nestle refers to Save the Children's comments on the prohibition on seeking direct or indirect contact with mothers. This is what the Code says in Article 5.5:

---5.5 Marketing personnel, in their business capacity, should not seek direct or indirect contact of any kind with pregnant women or with mothers of infants and young children.---

The reps. distributing the fliers to health workers to hand on to mothers are clearly seeking indirect contact with mothers. Evidence from other countries shows the reps. sometimes hand such fliers to mothers directly. We recently exposed such a case in India. See:http://www.babymilkaction.org/CEM/cemsept06.html

Okay, so Nestlé is violating the Code by providing these fliers for distribution to mothers. But, could it be the Code is wrong to have this prohibition and Nestlé's claim that such fliers are a 'safety measure' is justified?

Well, if the mothers targeted by these fliers need a picture to be able to identify the product (rather than a generic doctor's prescription to buy 'infant formula for use from birth', for example), how is she expected to understand the warnings and instructions on the labels?

Nestlé is admitting the purpose of the flier is to promote its products. If a health worker is going to advise a mother to use infant formula, why should they advise her to use NESTLÉ infant formula? Formulas have to comply with Codex standards. Here in the UK the Department of Health does not recommend one formula over another because they all have to have the composition specified in legislation.

Nestle may want to argue it is fine for it to promote Nestle products over the products of other companies. The problem is, however, that they also inevitably compete with breastfeeding.

This is why the International Code of Marketing of Breastmilk Substitutes states: "in view of the vulnerability of infants in the early months of life and the risks involved in inappropriate feeding practices, including the unnecessary and improper use of breastmilk substitutes, the marketing of breastmilk substitutes requires special treatment, which makes usual marketing practices unsuitable for these products."

Nestle claims its fliers have a 'breast is best' message - but again, if Nestle claims the fliers are for mothers who need a picture of the tin to be able to buy the correct product, how are they expected to read and understand the messages?

The Guardian investigation explains graphically the impact of aggressive marketing of breastmilk substitutes. For example:

---Quote begins

No shortage of mothers, and no shortage of sad tales. Because bottlefeeding is more than a health tragedy in this country: it is an economic tragedy, too. Happi Akther, 35, talks to me as she waits to see a doctor about her nine-month-old son's flaky-skin problem: Nur has been bottlefed, she says, since he was about a month old. "I felt I didn't have enough milk," says Happi, whose two previous babies both died soon after birth. "What else could I do? No one had any other ideas." (In fact, breastfeeding experts believe at least 98% of women - even those on nutritionally deficient diets in developing countries such as Bangladesh - can make sufficient milk to feed their babies, given proper advice and support.) Nur has been fed on Lactogen from the outset, but his formula, she says, costs her and her husband Gias, who works in a mustard-dyeing factory, around 800 taka (£2) a week. And if that doesn't sound much, set it against the fact that Gias earns only £6 a week. "We can't afford it at all," says Happi, shaking her head. "The milk uses up all our money." All the mothers I spoke to - most of whom were non-working wives whose husbands worked in factories or did manual jobs - had similar stories. (Of the 10 women I interviewed in the clinics, only one said she had begun using formula because she needed to go back to work.)

For some families, the burden of buying formula milk is simply too much. "They can't afford to mix it at the required proportion, so to make it go further they use too little powder," says Dr Roy. "Or they resort to using ordinary powdered milk, which is a lot cheaper to buy than branded baby formula. The result is babies whose milk is little more than what you might call white water."

According to Save the Children's report, infant mortality in Bangladesh alone could be cut by almost a third - saving the lives of 314 children every day - if breastfeeding rates were improved. Globally, the organisation believes, 3,800 lives could be saved each day. Given that world leaders are committed to cutting infant mortality by two thirds by 2015 as one of the Millennium Development Goals, protecting and promoting breastfeeding is almost certainly the biggest single thing that could be done to better child survival rates.

----quote ends

Despite the fact this marketing strategy is against the Code and that aggressive marketing undermines breastfeeding, having a negative impact it has on infants and their families, what can we make of Nestlé's claim that the fliers are a 'safety measure'?

However deluded, is Nestlé really motivated to hand out the fliers to reduce risks of formula? If that was its motivation wouldn't Nestlé take other steps to reduce the risks from formula? Infants have died because of intrinsic contamination of powdered infant formula with pathogens such as Enterobacter Sakazakii. New guidance has been issued stating that formula should be mixed with water at a higher temperature, 70 deg. C, to kill pathogens. Nestlé still refuses to revise its labels. It is left to organisations such as UNICEF to issue its own instructions with the correct information for mothers who formula feed.

You can find the leaflets prepared for use in the UK on the UNICEF website, because this is not only an issue for developing countries. A small number of infants in Europe have died after being fed with contaminated formula. Despite the deaths, Nestlé and other companies are refusing to change labels and are fighting moves for this to be a requirement in Codex standards. Why? Because any suggestion that powdered formula is not sterile may harm its image and sales. See:http://boycottnestle.blogspot.com/2007/02/powdered-infant-formula-is-not-sterile.html

So safety is not at the forefront of Nestlé's formula marketing strategy. Sales are.

Nestle uses similar marketing strategies in the Philippines, where it has also been exposed giving health workers inducements, a violation of article 7.3. See our Campaign for Ethical Marketing action sheet:http://www.babymilkaction.org/CEM/cemnov06.html

While pretending to respect the Code and referring misleadingly and selectively to is provisions, Nestle is admitting to a systematic breach - providing promotional fliers for infant formula to mothers via the health care system.

That it attempts to defend this practice is truly shocking - though nothing new. It wishes to divert criticism so it can continue, building sales for infant formula regardless of the impact on health.

I am not surprised that it has done so in this misleading way. I have debated with Nestle many times - including the author of the Guardian letter. We have won every debate where there has been a vote and now Nestle is refusing to attend any more.

We hope the Guardian will publish a response from us. Other than trying to raise awareness of what the World Health Assembly requirements actually say, there is little that we can do about Nestle's untrue claims when it makes them in a letter. When they claimed in an advertisement to market infant formula 'ethically and responsibly' we were able to challenge this before the Advertising Standards Authority. All of our complaints were upheld. See:http://www.babymilkaction.org/press/pressasa12may99.html

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